DHEC's Health and Environment Blog

When Breast Cancer Comes Back, Part 1

In 2015, DHEC’s Mary Bright wrote a blog post about her fight against breast cancer, the most common cancer among women. In late 2017, Mary learned that almost two years to the day that she had rung the bell as cancer-free, it had returned. She shares her latest story in a two-part blog series. Today: Part 1 of 2.

There are four words no cancer survivor ever wants to hear: Your cancer has returned.

It’s something all cancer patients know is a possibility, but after the first fight you try to be positive that you’ve kicked it and you’ll never have to face those four life-altering words.

For me it happened in November, almost exactly two years to the day after I rang the bell signifying that I’d completed my six-month grueling expedition into chemo, surgery and radiation treatment. As I sat down in the familiar leather seats in the infusion room, I thought about how ironic it was that two years prior I had rung my bell on the day before Thanksgiving. Now once again, on the day before Thanksgiving, I was settling in to begin chemo all over again.

‘I was looking forward to getting it out’

It had only been five months since I had undergone a CT scan that cleared me to have my port removed.

That little titanium port had saved my veins from being blown out two years earlier, when I sat through eight torturous rounds of chemo. The chemo that, at times, made me want to climb into a deep, dark hole and wish the world, one filled with unbearable pain and exhaustion, would go away. While the port had been surgically placed to help save my life, I was looking forward to getting it out. I told myself once my oncologist, Dr. Wells, gave the OK and we could take it out – that would be the signal that my life could begin to return to normal. With a clean CT scan, and once we passed my two-year anniversary, that tiny piece of titanium could go bye-bye.

Then, in early October, less than two months shy of my two-year anniversary, my bra began to pinch and hurt on my right side. I was having pain spasms that were increasing in frequency and painfulness. I swapped my normal bras for sports bras for a few days and it felt better; but only for a week or two. Then one day, just before Halloween, the pain returned and the skin of my right breast felt “thick” to the touch. The color was a light spotted pink like I had a mild, splotchy sunburn and, oddly, despite the previous lumpectomy, my right breast was looking fuller and sitting higher on my chest.

‘The next day, I got that call’

I had an appointment the next week for my fall follow-up so I mentioned it to my oncologist. He immediately sent me downstairs for a mammogram. A quick scan showed no changes in the density of the breast tissue so I went back upstairs to be re-evaluated. At that point, I was presenting symptoms that resembled mastitis, a painful infection/inflammation of the breast tissue. The other likely option was lymphedema; an overproduction of the lymphatic fluid from my arm that filled in the void areas in my breast after surgery.

Two rounds of antibiotics later, the color and swelling were down but not gone. Dr. Wells wanted an MRI to ensure tiny diffused cancerous cells weren’t hiding in the voids. So Nov. 6, about three weeks after the first symptoms, I went in for a chest/breast MRI.

The next day I got that call; Dr. Wells wanted me back in for a biopsy.

‘Yep, my cancer’s probably back.’

The MRI showed “spots of interest” on my right breast and inflamed lymph nodes on my left breast and in my lungs. I knew that meant the cancer was probably back, but no one really wanted to confirm that guess until they had test results. The Thursday before Veterans Day I went in and had six areas biopsied; three in the right breast and three in the left. A member of the medical staff asked foreshadowing questions and made comments that I assumed meant they knew what they were looking at — questions like whether we had removed my port yet. I said “No, I still have my port,” but brain said, “Yep, my cancer’s probably back.”

I was home the next day, Friday, for the state holiday when I got the results; all six samples were positive… déjà vu all over again. That’s exactly what I had been told the first time. Only this time my routine breast cancer had comeback with a vengeance. Instead of forming a solid tumor it hid in voids between the layers of my breast tissue making it harder to detect. My “routine” breast cancer, for reasons we may never know, was acting like a much more aggressive type of breast cancer known as triple negative. Triple negative is the most aggressive, the fastest-growing and deadliest form of breast cancer.

Triple negative breast cancers make up about 10-20 percent of all breast cancers; in about 34 percent of patients cancer comes back. On average, it reoccurs within about 2.6 years. Mine came back just shy of two years.

‘My cancer had spread to other organs’

Just like before, everything went into fast forward again. I had a PET Scan that Saturday to see if any other areas of my body contained cancerous cells; then a bronchoscopy the following Friday (to determine if the inflamed lymph node in my lungs was positive for cancer or just inflamed from a recent hacking cough). The lung spot, about the size of a quarter and in my lower left lung, was cancerous.

My cancer had spread to other organs. I was diagnosed as Stage IV.

Before I could even comprehend what was going on, I was sitting down to the first portion of the first round of chemo on November 22, the day I had expected to celebrate my two-year anniversary of being cancer-free.

How had this happened? Why had it come back? My cancer was supposed to be curable, after all. I was reassured of that. I could be cured and, in essence, walk away with only this minor detour from my life.

What didn’t happen with me that would have helped me? There are a couple of things I can remember.

‘The sad truth of it is… there is no good answer.’

I remembered being told that given my age on the first diagnosis – 40 years old –chemo might push me into early menopause. I remember thinking, “OK, one less thing to worry about.” I wasn’t planning on kids after 40. My periods did stop about six weeks into chemo, but about five months after I stopped chemo, I woke up and it was back. I told my oncologist and he seemed

a tad surprised but told me that occurs for some women, usually those with excess estrogen production. He recommended I start a drug called Tamoxifen (to reduce estrogen production) and seriously consider having an Oopherectomy (removing my ovaries) within the next year, since that’s another place where estrogen is produced. I couldn’t tolerate the drug so we tried a different one, Letrozole, which wasn’t any better.

That’s when we decided to go ahead with a full Hysterectomy and Oopherectomy. Since we were “going in” it would be better to take out the uterus, fallopian tubes, cervix and anything else that could cause any of the “silent” feminine cancers in the future.

‘What was this new diagnosis going to mean for me?’

But was there anything else we missed? No. So what had happened?

The sad truth of it is… there is no good answer. Sometimes, as my oncologist said, people with no family history and no genetic mutations simply develop cancer. It’s an unlucky roll of the dice.

What was this new diagnosis going to mean for me? For my future? For my family?